Creating advance directives

Advance directives need to be in writing. Each state has different forms and requirements for creating legal documents. Depending on where you live, a form may need to be signed by a witness or notarized. You can ask a lawyer to help you with the process, but it is generally not necessary.

Links to state-specific forms can be found on the websites of various organizations such as the American Bar Association and the National Hospice and Palliative Care Organization. The American Bar Association also has a basic, easy-to-use advance directive form that can be used in most states.

Review your advance directives with your doctor and your health care agent to be sure you have filled out forms correctly. When you have completed your documents, you need to do the following:

Keep the originals in a safe but easily accessible place.

Give a copy to your doctor.

Give a copy to your heath care agent and any alternate agents.

Keep a record of who has your advance directives.

Talk to family members and other important people in your life about your advance directives and your health care wishes.

Carry a wallet-sized card that indicates you have advance directives, identifies your health care agent, and states where a copy of your directives can be found.

Keep a copy with you when you are traveling.

Reviewing and changing advance directives

You can change your directives at any time. If you want to make changes, you must create a new form, distribute new copies and destroy all old copies. Specific requirements for changing directives may vary by state.

You should discuss changes with your primary care doctor and make sure a new directive replaces an old directive in your medical file. New directives must also be added to medical charts in a hospital or nursing home. Also, talk to your health care agent, family and friends about changes you have made.

You should consider reviewing your directives and creating new ones in the following situations:

New diagnosis. A diagnosis of a disease that is terminal or that significantly alters your life may lead you to make changes in your living will. Discuss with your doctor the kind of treatment and care decisions that might be made during the expected course of the disease.

Change of marital status. When you marry, divorce, become separated or are widowed, you may need to select a new health care agent.

Change in wishes. Over time your thoughts about end-of-life care may change. Review your directives from time to time to be sure they reflect your current values and wishes.

Physician orders for life-sustaining treatment (POLST)

In some states, advance health care planning includes a document called physician orders for life-sustaining treatment (POLST). The document may also be called provider orders for life-sustaining treatment (POLST) or medical orders for life-sustaining treatment (MOLST). Your doctor fills out this form.

A POLST is intended for people who have already been diagnosed with a serious illness. This form does not replace your other directives. Instead, it serves as doctor-ordered instructions — not unlike a prescription — to ensure that, in case of an emergency, you receive the treatment you prefer.

A POLST stays with you. If you are in a hospital or nursing home, the POLST is posted near your bed. If you are living at home or a hospice care facility, the POLST is prominently displayed where emergency personnel or other medical team members can easily find it.

Your doctor will fill out the form based on the contents of your directives, discussions with your doctor about the likely course of the illness, and your treatment preferences.

Forms vary by state, but essentially a POLST enables your doctor to include details about what treatments not to use, under what conditions certain treatments can be used, how long treatments may be used, and when treatments should be withdrawn. Issues covered in a POLST may include:

Resuscitation

Mechanical ventilation

Tube feeding

Use of antibiotics

Requests not to transfer to an emergency room

Requests not to be admitted to the hospital

Pain management

A POLST also indicates what advance directives you have created and who serves as your health care agent. Like advance directives, POLSTs can be canceled or updated.

Advance care planning: Ensuring your wishes are known and honored if you are unable to speak for yourself. http://www.cdc.gov/aging/pdf/advanced-care-planning-critical-issue-brief.pdf. Centers for Disease Control and Prevention. Accessed April 30, 2014.

Giving someone a power of attorney for your health care: A guide with an easy-to-use, legal form for all adults. American Bar Association. http://www.americanbar.org/groups/law_aging/resources/health_care_decision_making/power_atty_guide_and_form_2011.html. Accessed April 30, 2014.

Put it in writing: Questions and answers on advance directives. American Hospital Association. http://www.aha.org/advocacy-issues/initiatives/piiw/index.shtml. Accessed April 30, 2014.

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